Community health workers provide bridge between researchers and the community

Community Health Workers (CHWs) are trusted frontline public health workers who often function as liaisons or intermediaries between health and social services and the community. Their activities can include outreach, community education, informal counseling, social support, advocacy, and — increasingly — research.

More CHWs are serving as active members of research teams at the University at Buffalo. At the forefront of this partnership is the UB Clinical and Translational Science Institute (CTSI), which has long prioritized the knowledge and skill sets of CHWs.

CTSI Recruitment and Special Population Co-director Renee Cadzow, PhD, Assistant Professor, Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, has been involved with local CHWs since 2012. She has supported the Community Health Worker Network of Buffalo as a training facilitator and an evaluator, and has served as a board member and co-chair. Cadzow says having “the presence of somebody who really links and bridges to community” on a research team can have a measurable impact on whether a study is successful.

“Any research that addresses social determinants of health can benefit from having one or more Community Health Workers on the team,” she says. “You maximize the chance of your research question being relevant, your research methods being appropriate and well received, and your ability to then — if you are doing human subjects research — recruit and retain participants.”

Growing impact

CHWs have existed in the United States for more than 70 years. Cadzow explains that CHWs have been working in nonprofit as well as healthcare sectors to address social determinants of health through outreach and home visitation. During COVID-19, this became particularly important and highlighted their role in community health and wellbeing.

As the roles of CHWs evolved, so did their involvement with and impact on research. Evidence showed they were having a clear impact on health outcomes.

“Until recently, many people have been unaware of CHWs and their impact,” Cadzow says. “So, there was a new understanding within healthcare of their role in addressing social determinants of health, and that also goes hand-in-hand with healthcare's increased focus on these issues.”

Collaborating with Community Health Workers is key to the CTSI’s goal of advancing research discoveries to improve health for all. In her role, Cadzow has been at the forefront of connecting the university community — investigators, research staff, administrators — with CHWs.

“We have implemented trainings and programs that help different populations understand the role of addressing social needs, while also encouraging partnership with Community Health Workers towards research so that investigators understand the needs of community. This community-based perspective should be driving the research questions that we ask and the ways that we seek answers to those questions in partnership.”

Making connections, bridging gaps

Jessica Bauer Walker is Executive Director of CoNECT (Community Network for Engagement, Connection and Transformation), a network of frontline workers, community organizers and advocates in the areas of healthcare, public health, housing, education, environment, food access, and social services. She serves the same role with the Community Health Worker Network of Buffalo, and is a CHW herself. Bauer Walker is a member of the CTSI Board, comprised of leading academic, healthcare and research institutions and key community partners in the Buffalo region.

Bauer Walker says early involvement in a project makes a difference. “CHWs are often asked to deliver an intervention or gather information from directly impacted communities without having been involved in the project design. This opportunity of CHW/researcher teams working in full partnership leverages the best aspects of academic rigor as well as community and cultural responsiveness to make research and evaluation more robust and impactful.” 

Cadzow hopes to see continued growth in intentionally driven community-partnered research. Those efforts, she says, take time and effort, but the results are tremendous. One way to get started is to connect with the CHW Allies and Academics Group, which meets every other month and discusses ways to connect researchers with community members.

“Finding somebody to mentor or provide guidance can make a researcher feel more comfortable reaching out,” says Cadzow. “Another researcher may be able to provide that bridge to organizations or individuals they have worked with in the past.” Contact Cadzow at rcadzow@buffalo.edu for more information on the group.

Bauer Walker believes it is also important for researchers to go into the community and engage with people on a personal basis.

“Spend time building trust and relationships in community. Do a lot of listening. Value CHW and community knowledge, skills, and experience and make sure that you are bringing value as a researcher and not perpetuating extractive and harmful dynamics that have led to mistrust of academia and researchers.”

Once one or more CHWs are engaged on a team, Cadzow stresses that researchers must understand and value that they might be the only voice in the room that speaks up for the community. Trained in advocacy and understanding dynamics of power and privilege, they are not afraid to use their voice, even if they are the only non-PhD or non-MD in the room.

Broadening perspectives

Katie C. Stalker, PhD, MSW, Associate Professor and Director of Field Education, School of Social Work, was part of the national evaluation team for the CDC’s Community Health Workers for COVID Response and Resilient Communities (CCR) initiative. It involved CHWs to support the response to COVID and engage with the community. “Community Health Workers were able to steer the direction of the national evaluation,” she says.

Based on her experience, Stalker calls CHWs “invaluable,” and highly recommends that community-engaged researchers involve CHWs as members of their research teams.

“CHWs’ lived experience and training make them experts in engaging communities, understanding community opportunities and challenges, and developing solutions,” she explains.

Cadzow points out that CHWs may have some formal education, or they may not. “As researchers, we need to value that kind of knowledge and recognize it as valuable. It is time to broaden our perspectives,” she believes.

"The ability of community health workers to represent the interest of their constituencies cannot be underestimated,” says CTSI Recruitment and Special Populations Core Co-director Teresa Quattrin, MD, UB Distinguished Professor, Department of Pediatrics, and Associate Dean for Research Integration, Jacobs School. “They make us researchers much more aware of what matters to community members. This is an essential step to ensure that any research is conducted in partnership with and directed by the will of the community. It also paves the way to co-creation of projects that answer questions relevant to the community.”

CTSI Community Engagement Core Director Laurene Tumiel-Berhalter, PhD, Director of Community Translational Research, Department of Family Medicine, Jacobs School, says the CTSI is developing training for researchers to enhance their ability to engage successfully with CHWs to conduct research that is more relevant to community priorities. “Collaborating with community health workers on a research team is founded on the principles of community engagement and will function differently than the traditional research coordinator model,” she adds.

To learn more about working with Community Health Workers, Cadzow recommends getting in touch with Buffalo Translational Consortium member institution CoNECT. She suggests exploring national organizations such as the National Association of Community Health Workers, the National Council on CHW Core Consensus Standards, and the Community Health Worker Center for Research and Evaluation. In addition, researchers are encouraged to make a service request to the CTSI’s Community Engagement and/or Recruitment and Special Populations cores.

“Our research will have a greater impact if we can engage our communities,” states CTSI Director Timothy F. Murphy, MD, SUNY Distinguished Professor. “CHWs are trained to participate in and guide the research, including what questions we should be investigating and asking. Advancing the role of these individuals helps us ensure that we have meaningful, bidirectional community partnerships.”

This article was first published by the UB Clinical and Translational Science Institute.